Program Manager, Quality Improvement

Program Manager, Quality Improvement

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Program Manager (Quality Improvement) and help shape the future of healthcare where you'll be an integral part of our Quality Improvement team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Program Manager for Quality Improvement (QI) will provide oversight, coordination and staff support to the department for National Committee for Quality Assurance (NCQA) Accreditation, as well as for the quality requirements of the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and Centers for Medicare & Medicaid Services (CMS). You will support CalOptima Health's health plan and health equity accreditation efforts to ensure CalOptima Health achieves its renewal accreditation. Specifically, you will work to monitor, enhance and strengthen CalOptima Health's quality infrastructure, including program, policy, contract compliance and statutory and regulatory obligations with NCQA, DHCS, DMHC and CMS. You will require the ability to complete a variety of detailed analyses, including the impact of accreditation and policy changes from the NCQA, state of California, federal government, and regulatory entities while communicating these changes with QI leadership and affected areas. You will assist in developing and overseeing the Quality Improvement Health Equity Transformation Plan (QIHETP), and the annual work plan and evaluation, including ensuring alignment with organizational goals and regulatory requirements. You will interact with CalOptima Health's leadership, the NCQA, and state and federal regulatory agencies. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 80% - Program Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Leads CalOptima Health through the NCQA Health Plan and Health Equity accreditation process and renewals for all applicable products and provides leadership to all business areas to ensure standards are known and met.
  • Leads and facilitates NCQA regulatory audits and audit readiness activities for the department.
  • Stays current on NCQA accreditation standards as well as local, state and federal health care environment; identifies issues and communicates areas that may impact CalOptima Health's QI programs.
  • Ensures all NCQA related policies are reviewed and updated to meet NCQA and regulatory compliance annually; works directly with regulatory and compliance to ensure submissions are reviewed timely and with legal review.
  • Assists in the development and bookmarking of documents used for NCQA accreditations and other regulatory agency reporting submissions.
  • Engages and collaborates with all external NCQA and regulatory related vendors and organizations, including but not limited to NCQA and NCQA consultants, to ensure standards are known and met and accreditation surveys are submitted accurately and timely.
  • Initiates and maintains contact with key business owners to ensure proper submission of required documentation for the accreditation and renewal survey and regulatory audits.
  • Assists the manager and director in developing annual regulatory compliant QIHETP documents, including the QIHETP description, annual workplan and evaluation.
  • Monitors quality improvement actions and activities across the organization to ensure the QIHETP description and annual work plan are executed as planned and meet regulatory requirements.
  • Manages policies for the department and collaborates with the appropriate business owners to update policies as needed to maintain compliance with NCQA, DHCS, DMHC, CMS, and other regulatory requirements.
  • Represents QI at various CalOptima Health committee meetings such as the Quality Improvement Health Equity Committee (QIHEC) and its related subcommittees or workgroups.
  • Designs and develops process improvements for the department to support and ensure NCQA and regulatory compliance.
  • Engages and collaborates with both internal and external audit and oversight departments to ensure that NCQA standards and quality requirements are met.
  • Manages the accurate and timely submission of regulatory filings and reporting requirements on an ongoing basis.
    
    
• 15% - Administrative Support
  • Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message.
  • Researches national, state and local health policy issues that may impact CalOptima Health's mission, vision and strategic goals.
  • Supports the manager in preparing and facilitating the NCQA Steering Committee meeting.
  • Represents the department in various internal and external meetings.
  • Provides program support to managers and other team members, assuring PQI, credentialing, FSR and PARS processes are compliant with regulatory or audit and accreditation requirements.
  • Manages and facilitates file review audits with internal staff and delegated networks.
    
    
• 5% - Other
  • Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor's degree in health care or related field PLUS 3 years of experience working with health care delivery systems and/or in a public agency serving the related population; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  
• 3 years of experience in program and/or project management.
  
• 2 years of experience within managed care or quality management.

You'll Stand Out More If You Possess the Following:

• 2 years of experience with outreach and public speaking or public relations.
  
• 2 years of experience successfully managing and achieving NCQA accreditation for a health plan or equivalent.
  
• 1 year of experience and aptitude for working in a highly matrixed, mission-driven organization.

What the Regulatory Agencies Need You to Possess?

• n/a

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
      
      
• This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is February 11, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

Our Commitment to You

Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.

We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


To apply, please visit: https://jobs.caloptima.org/jobs/program-manager-quality-improvement-505-city-parkway-west-california-united-states







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